Verification Cover
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Void Information
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Date
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Void Address
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Type of property
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Number of bedrooms
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How was your application made?
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Would you recommend our website to your friends or family who are working and looking for housing?
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If for any reason you are unable to move into this property are you aware you are able to save your search for the areas of your choice on our website?
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Please state
Household Details
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Main Applicant Information
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Title
- Mr
- Mrs
- Miss
- Ms
- Dr
- Mstr
- Other
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First Name(s)
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Surname
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Date of Birth
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Sex
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Nationality *Other EEA Countries Include Austria, Belgium, Cyprus, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, Malta, Netherlands, Portugal, Spain, Sweden, Iceland, Lichtenstein, Norway and Switzerland.
- 1 UK National Resident
- 2 UK National returning from overseas
- 3 Czech Republic
- 4 Estonia
- 5 Hungary
- 6 Latvia
- 7 Lithuania
- 8 Poland
- 9 Slovakia
- 10 Slovenia
- 11 Other EEA Country
- 12 Any other Country
- 13 Prefer not to answer
- 14 Bulgaria
- 15 Romania
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Ethnic Group
- 1 White English, Scottish, Welsh, Northern Ireland, British
- 2 White Irish
- 3 Gypsy / Irish Traveller
- 4 White Other
- 5 Mixed White / Black Carribbean
- 6 Mixed White / Black African
- 7 Mixed White / Black Asian
- 8 Mixed White / Black Other
- 9 Asian / Asian British Indian
- 10 Asian / Asian British Pakistan
- 11 Asian / Asian British Bangladeshi
- 12 Asian / Asian British Chinese
- 13 Asian / Asian British Other
- 14 Black African / Caribbean / Black British Caribbean
- 15 Black African / Caribbean / Black British African
- 16 Black African / Caribbean / Black British Other
- 17 Other Ethnic Group Arab
- 18 Other Ethnic Group Other
- 19 Prefer not to answer
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Religion
- 1 Christian
- 2 Hindu
- 3 Muslim
- 4 Sikh
- 5 Jewish
- 6 Buddhist
- 7 No Religion
- 8 Other
- 9 Prefer not to answer
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Sexuality
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Disability
- 1 Not Disabled
- 2 Hearing Disability
- 3 Mental Health
- 4 Speech Impairment
- 5 Learning Disability
- 6 Mobility Disability
- 7 Visual Disability
- 8 Other Disability
- 9 Prefer not to answer
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Are you currently working?
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Please state
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Employers name
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Employers address
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Employers telephone number(s) / email address
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Length of time employed
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Telephone Number(s)
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Email address
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National Insurance Number
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Next of Kin details, include Name, Address, telephone number and email where possible
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Reason for rehousing
- Permanent Decant
- Issues with neighbours
- Unsuitable due to ill health
- Can't afford rent / mortgage
- To move near work
- To move to independent accommodation
- Relationship Breakdown (non violent)
- Racial Harassment
- Overcrowding
- Poor condition
- To move near family / friends
- To move near accommodation with support
- Financial difficulties
- Domestic violence
- Medical Needs
- Other
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Please state reason
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Which member(s) of the household has a medical need to move?
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Please confirm that you have fully discussed the applicants medical and housing needs. By ticking this box you are confirming that the property they are applying for meets their medical needs.
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Will the applicant require a PEEP (Personal Emergency Evacuation Plan)?
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Household Details
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Other people living with you
Household Member
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Status
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Relationship to main applicant
- Partner
- Son
- Daughter
- Father
- Mother
- Brother
- Sister
- Extended Family
- Not Related
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Title
- Mr
- Mrs
- Miss
- Ms
- Dr
- Mstr
- Other
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First Name(s)
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Surname
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Date of Birth
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Sex
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Nationality *Other EEA Countries Include Austria, Belgium, Cyprus, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, Malta, Netherlands, Portugal, Spain, Sweden, Iceland, Lichtenstein, Norway and Switzerland.
- 1 UK National Resident
- 2 UK National returning from overseas
- 3 Czech Republic
- 4 Estonia
- 5 Hungary
- 6 Latvia
- 7 Lithuania
- 8 Poland
- 9 Slovakia
- 10 Slovenia
- 11 Other EEA Country
- 12 Any other Country
- 13 Prefer not to answer
- 14 Bulgaria
- 15 Romania
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Ethnic Group
- 1 White English, Scottish, Welsh, Northern Ireland, British
- 2 White Irish
- 3 Gypsy / Irish Traveller
- 4 White Other
- 5 Mixed White / Black Carribbean
- 6 Mixed White / Black African
- 7 Mixed White / Black Asian
- 8 Mixed White / Black Other
- 9 Asian / Asian British Indian
- 10 Asian / Asian British Pakistan
- 11 Asian / Asian British Bangladeshi
- 12 Asian / Asian British Chinese
- 13 Asian / Asian British Other
- 14 Black African / Caribbean / Black British Caribbean
- 15 Black African / Caribbean / Black British African
- 16 Black African / Caribbean / Black British Other
- 17 Other Ethnic Group Arab
- 18 Other Ethnic Group Other
- 19 Prefer not to answer
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Religion
- 1 Christian
- 2 Hindu
- 3 Muslim
- 4 Sikh
- 5 Jewish
- 6 Buddhist
- 7 No Religion
- 8 Other
- 9 Prefer not to answer
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Sexuality
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Disability
- 1 Not Disabled
- 2 Hearing Disability
- 3 Mental Health
- 4 Speech Impairment
- 5 Learning Disability
- 6 Mobility Disability
- 7 Visual Disability
- 8 Other Disability
- 9 Prefer not to answer
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Telephone Number
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Email Address
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Next of Kin details, include Name, Address, telephone number and email where possible
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National Insurance Number
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Are they currently working?
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Please state
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Employers name
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Employers address
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Employers telephone number(s) / email address
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Length of time employed
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Does this person currently live with you?
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Current Address
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Relationship to main applicant
- Partner
- Son
- Daughter
- Father
- Mother
- Brother
- Sister
- Extended Family
- Not Related
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Title
- Mr
- Mrs
- Miss
- Ms
- Dr
- Mstr
- Other
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First Name(s)
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Surname
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Date of Birth
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Sex
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Nationality *Other EEA Countries Include Austria, Belgium, Cyprus, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, Malta, Netherlands, Portugal, Spain, Sweden, Iceland, Lichtenstein, Norway and Switzerland.
- 1 UK National Resident
- 2 UK National returning from overseas
- 3 Czech Republic
- 4 Estonia
- 5 Hungary
- 6 Latvia
- 7 Lithuania
- 8 Poland
- 9 Slovakia
- 10 Slovenia
- 11 Other EEA Country
- 12 Any other Country
- 13 Prefer not to answer
- 14 Bulgaria
- 15 Romania
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Ethnic Group
- 1 White English, Scottish, Welsh, Northern Ireland, British
- 2 White Irish
- 3 Gypsy / Irish Traveller
- 4 White Other
- 5 Mixed White / Black Carribbean
- 6 Mixed White / Black African
- 7 Mixed White / Black Asian
- 8 Mixed White / Black Other
- 9 Asian / Asian British Indian
- 10 Asian / Asian British Pakistan
- 11 Asian / Asian British Bangladeshi
- 12 Asian / Asian British Chinese
- 13 Asian / Asian British Other
- 14 Black African / Caribbean / Black British Caribbean
- 15 Black African / Caribbean / Black British African
- 16 Black African / Caribbean / Black British Other
- 17 Other Ethnic Group Arab
- 18 Other Ethnic Group Other
- 19 Prefer not to answer
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Religion
- 1 Christian
- 2 Hindu
- 3 Muslim
- 4 Sikh
- 5 Jewish
- 6 Buddhist
- 7 No Religion
- 8 Other
- 9 Prefer not to answer
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Sexuality
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Disability
- 1 Not Disabled
- 2 Hearing Disability
- 3 Mental Health
- 4 Speech Impairment
- 5 Learning Disability
- 6 Mobility Disability
- 7 Visual Disability
- 8 Other Disability
- 9 Prefer not to answer
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Does this person currently live with you?
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Current Address
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Further Household Information
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Is any member of the household pregnant?
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Name
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Due date
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Are any members of the household persons from abroad?
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What is their Country of origin?
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Nationality
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What is their residency status? E.g. Unlimited leave to remain / leave to remain.
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If limited leave to remain please state the expiry date.
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Do they have recourse to public funds? I.e. Can they claim benefits.
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How long have they been in the UK?
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How long have they worked in the UK?
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Has any of the household members ever served in the Armed Forces?
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Details
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Has any of the household members ever been injured while serving as a reservist?
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Details
Address History
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Have any of the household members ever been a tenant with Places for People before?
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Property Address
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Tenancy start date
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Tenancy end date
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Reason for leaving
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Address History
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Which Local Authority do you currently live in?
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How long have you lived in the Local Authority you are moving to?
- New to the LA
- 1 year
- 2 years
- 3 years
- 4 years
- 5 years +
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Previous 3 years Address history
Address
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Date from
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Date to
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Address
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Reason for leaving
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Landlord contact details
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Pets
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Do you have any pets?
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Details
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Pet Policy explained
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Starting up a Home
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Do you have any furniture for the property?
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Please provide details of advice given and state how the applicant proposes to furnish the property.
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Furniture Package discussed?
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Disclosure of Interests
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Is anyone in your household, including close relatives, related to a member of staff, a member of our customer panels or groups?
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Name
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Relationship to you
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What panel or group do they belong to?
Additional Information
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Criminal Conviction Declaration
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Have you or anyone in your household ever had any convictions, including youth convictions, cautions, pending and spent convictions?
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Please provide details
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Do you or any of your household have any criminal convictions which are not spent?
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Details of conviction(s), including name of offender, date of conviction and when it will be spent
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Have you or anyone in your household ever been involved in or investigated for acts of nuisance or anti-social behaviour, including noise and youth nuisance?
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Please provide details
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Support Needs
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Have you or anyone in your household had any support needs, either current or previous, e.g. Tenancy support, health, mental health, domestic abuse, parenting, substance / alcohol, etc.
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Please provide details
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Do you feel you have an unmet need for support?
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Details of support required, referrals to be made by whom and when, etc
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Do you feel you have an unmet need for support?
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Details of support required, referrals to be made by whom and when, etc
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Have you or anyone in your household ever been involved with any support agencies, e.g. CMHT, Social Services, Probation, etc.
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Please provide details
Income / Expenditure
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Income and Expenditure
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Is a full income and expenditure analysis needed?
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Income and expenditure frequency
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INCOME
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Salary
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Amount
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Benefits
- JSA
- ESA
- Income Support
- DLA (care/mob)
- Tax Credits
- Pension Credit
- Carers Allowance
- Attendance Allowance
- State Pension
- Statutory Sick Pay (SSP)
- Statutory Maternity Pay (SMP)
- Widows Pension
- Incapacity Benefit
- Universal Credit
- Child Benefit
- Any other benefit (please state)
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Amount(s)
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Child Maintenance
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Amount
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Private / Company Pension(s)
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Amount
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Family Contribution
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Amount
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TOTAL INCOME
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EXPENDITURE
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Mortgage / Rent
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Amount
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Mortgage endowment
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Amount
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Mortgage arrears
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Amount
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Secured loan
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Amount
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Council Tax
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Amount
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Buildings / contents insurance
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Amount
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Life insurance
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Amount
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Pension
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Amount
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Gas / electric
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Amount
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Water Rates
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Amount
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Telephone
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Amount
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TV Licence
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Amount
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TV / Video Rental
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Amount
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Food / cleaning / toiletries
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Amount
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Tobacco / Alcohol
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Amount
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Clothing
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Amount
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Child Maintenance
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Amount
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School Meals
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Amount
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Health costs
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Amount
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Do you have a car?
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Car Finance
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Car Insurance
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Servicing / Recovery
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Petrol
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Bus pass / regular travel expenses
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Any other expenditure
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Details
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Amount
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TOTAL EXPENDITURE
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BALANCE (SHORTFALL)
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Why?
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Savings Amount
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Details of any debts, e.g. Credit cards, loans, etc.
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Do you earn over £30k per year?
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Explained social housing rent rises for high earners
Affordability
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AFFORDABILITY
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HBSP to be recorded?
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Affordability discussed
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Guide to cost of renting your own home given
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Confirmed customer has their own current bank account
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Confirmed minimum rent payment at sign up and this needs to be by debit card
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How will the rent be paid?
- Direct Debit
- Housing Benefit
- Swipe Card
- Debit Card online / phone
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Frequency
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Preferred collection date
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Have you ever had any rent arrears / housing related debt?
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Details
Verification documents
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Additional Information
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Is there any additional information that needs to be recoded?
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Details
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VERIFICATION DOCUMENTS RECEIVED / TO FOLLOW
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Applicant 1 - Received
- Proof of ID
- Proof of Income
- Employment Reference
- Medical Confirmation
- Landlord / Mortgage Reference
- Proof of Residency
- Passport / Home Office Letter (Leave to remain)
- Character Reference
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Applicant 1 - To Follow
- Proof of ID
- Proof of Income
- Employment Reference
- Medical Confirmation
- Landlord / Mortgage Reference
- Proof of Residency
- Passport / Home Office Letter (Leave to remain)
- Character Reference
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Applicant 2 - Received
- Proof of ID
- Proof of Income
- Employment Reference
- Medical Confirmation
- Landlord / Mortgage Reference
- Proof of Residency
- Passport / Home Office Letter (Leave to remain)
- Character Reference
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Applicant 2 - To Follow
- Proof of ID
- Proof of Income
- Employment Reference
- Medical Confirmation
- Landlord / Mortgage Reference
- Proof of Residency
- Passport / Home Office Letter (Leave to remain)
- Character Reference
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Agreed deadline for outstanding references to be provided
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Is applicant being recommended for rejection?
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Signature
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Welcome visit band
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Type of Tenancy Agreement
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Reasons for rejection
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Signature
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Previous person check completed on Northgate
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ReAct search completed